CONCUSSION MANAGEMENT PROTOCOL CONTENTS CONCUSSION MANAGEMENT GUIDELINES Guidelines INDEPENDENT MEDICAL CARE GUIDELINES Appendix A FOOTBALL PRACTICE GUIDELINES Appendix B CONCUSSION: A FACT SHEET FOR STUDENT-ATHLETES Appendix C STUDENT-ATHLETE CONCUSSION STATEMENT ACKNOWLEDGEMENT Appendix D BASELINE ASSESSMENT SYMPTOM SCALE Appendix E CONCUSSION: A FACT SHEET FOR COACHES Appendix F ATHLETIC STAFF CONCUSSION STATEMENT ACKNOWLEDGEMENT Appendix G CONCUSSION HEAD INJURY INFORMATION TAKE-HOME INSTRUCTIONS Appendix H CONCUSSION ASSESSMENT SYMPTOM SCALE Appendix I CONCUSSION AWARENESS LETTER Appendix J EMERGENCY ACTION PLAN Appendix K CONCUSSION SAFETY PROTOCOL CHECKLIST Appendix L Updated 3/27/2019 CONCUSSION MANAGEMENT GUIDELINES I. INTRODUCTION The NCAA Executive Committee has developed a consistent, association-wide approach to Concussion Management. It is the responsibility of all student-athletes to report injuries and illnesses to their Athletic Trainer. This includes, but is not limited to, signs and symptoms related to concussions. The Clemson University Sports Medicine Department recognizes and acknowledges that concussions or traumatic brain injuries (TBI) need immediate attention. A concussion is defined as a generally short-lived impairment of neurological function brought on by a direct or indirect traumatic force applied to the head or body. Symptoms are usually rapid in onset, but of short duration and generally resolve spontaneously. It is usually a functional disturbance and not a structural one. Loss of consciousness may or may not be involved. Exact recovery periods from these types of head injuries are uncertain and will often vary. Clemson University Sports Medicine adheres to the NCAA Legislation 3.2.4.17 Concussion Management Plan. In addition, Clemson University Sports Medicine abides by the Independent Medical Care Guidelines (APPENDIX A) and Football Practice Guidelines (APPENDIX B) as addressed by the Safety in College Football Summit. All members of the Clemson University Sports Medicine staff will abide by the scope of their established professional practice. The Certified Athletic Trainers and Team Physicians of the Clemson University Sports Medicine staff are trained in the diagnosis, treatment and initial management of acute concussions. During NCAA competition of the following Clemson University sports; Football, Men and Women’s Basketball, Men and Women’s Soccer and Pole- vaulting, there will be a member of the Clemson University Sports Medicine staff on-site at the venue to manage any concussion related problems as it is written in our general protocol. In addition, as it pertains to the above listed sports, a member of the Clemson University Sports Medicine staff, at minimum, will be available during NCAA practices. Availability of staff is defined by being accessible at any time during these practices by means of telephone, messaging, email, beeper or any other immediate communication vehicle. A staff member will attend along with being available for the Clemson University practices of the previously listed sports. All of the concussion management progression lies exclusively with the Clemson University Sports Medicine Staff, and The Team Physician will make the final determination of return-to-play once asymptomatic and post-exertion assessments are within normal limits. The entire concussion management process of the student-athlete from the baseline assessment, initial post-injury evaluation, and eventual return to full athletic and academic participation, including any diagnostic testing, shall be documented within their medical file. II. BASELINE ASSESSMENT / EDUCATION Prior to any athletic activity, every student-athlete will be required to sign a Student-Athlete Concussion Statement Acknowledgement (APPENDIX D) annually stating they receive, have read, and understand the information provided by the NCAA document Concussion: A Fact Sheet for Student-Athletes (APPENDIX C). This document on concussions includes the definition of a concussion, how to prevent a concussion, the symptoms of a concussion, and how to report any concerns for themselves, or a teammate regarding a concussion. Before any athletic participation, every student-athlete will undergo baseline testing. Baseline testing includes a medical history, a Baseline Assessment Symptom Scale with a Balance Error Scoring System (BESS) (APPENDIX E), and a computerized neuropsychological test. All Clemson University Coaches, Strength and Conditioning Staff, Athletic Trainers, Team Physicians, Nieri Academic Staff, and the Director of Athletics will be required to sign an Athletic Staff Concussion Statement Acknowledgment (APPENDIX G) annually stating that they receive, have read, and understand the information provided by the NCAA document Concussion: A Fact Sheet for Coaches (APPENDIX F). This document includes facts and the definition of a concussion, signs and symptoms to be aware of, how to prevent concussions, and what to do if they suspect a concussion has occurred in a student-athlete. In an attempt to educate student-athlete’s playing football, the Clemson University Football coaches go over drills to teach proper form prior to contact during fall and spring practice. These sessions are videoed and kept on file. III. CONCUSSION The Clemson University Sports Medicine team will determine whether or not a concussion has occurred, realizing that each concussion and each student-athlete are different and individual treatment plans are necessary. Signs and Symptoms of a Possible Concussion (including but not limited to): • Headache • Difficulty Sleeping • Nausea • Misophonia – Noise Sensitivity • Balance Problems • Blurred Vision • Dizziness • Feeling Sluggish or Groggy • Diplopia - Double Vision • Memory Problems • Confusion • Difficulty Concentrating • Photophobia – Light Sensitivity Page 1 of 3 When a student-athlete exhibits signs, symptoms, or behavior consistent with a possible concussion, they shall be removed from practice or competition and evaluated by the Certified Athletic Trainer and/or the Team Physician. The student-athlete will be evaluated and monitored for a minimum of 15 minutes to determine their status as it relates to being concussed. Once a student-athlete has been diagnosed with having a concussion, they shall be removed from physical activity for the remainder of that day, and not allowed to participate in academic activities. The student-athlete, or their parent, guardian, or roommate, will be provided instructions on further care and the Concussion Head Injury Information Take-Home Instructions (APPENDIX H) upon discharge. The student-athlete will be monitored multiple times daily for progression of symptoms from rest, physical exertion, and mental exertion by the Clemson University Sports Medicine staff. The student-athlete will see a Team Physician every morning, and at other times throughout the day as deemed necessary, to determine their status as it pertains to their concussion symptoms, their athletic participation status, and their academic participation status. The Clemson University Sports Medicine Staff will use a Concussion Assessment Symptom Scale (APPENDIX I) and a Balance Error Scoring System (BESS) daily, along with other examinations deemed necessary during the evaluation of the concussed student-athlete until the symptoms have subsided and/or have been resolved. A computerized neuropsychological test will also be performed, however, computer neuropsychological tests should not be used as a standalone measure to diagnose the presence or absence of a concussion. All of these evaluations will be compared to the baseline values of the student-athlete and will aid in the Return-to-Play and Return-to-Learn progression. In the case of a prolonged recovery, the team physician will determine the need for further diagnostic imaging, testing, or outside consultation on a case-by-case basis. With permission for release of information from the student-athlete, the Nieri Academic Advisors and their Professors will be notified and updated on the condition of the student-athlete after they suffer from a concussion. IV. EMERGENCY ACTION Clemson University Sports Medicine personnel will execute the Clemson University Sports Medicine Emergency Action Plan (APPENDIX K) for further medical care and/or transportation as deemed necessary. This may include injury to the neck and/or spine, head trauma, and/or severe concussion signs and/or symptoms. The following items will be used to determine the status of the student-athlete as it pertains to transportation to a medical facility and/or initiating the Emergency Action Plan: 1. A Glasgow Coma Scale that diminishes below a 13 2. Prolonged loss of consciousness as it relates to the concussion 3. A neurological exam deficit that may suggest intracranial trauma 4. Repetitive/Uncontrolled vomiting (Emesis) 5. A persistent decline of the student-athlete's mental status and/or neurological signs/symptoms 6. Significant spinal related trauma/injury V. RETURN-TO-PLAY The Athletic Trainer and the Team Physician will monitor the progression of the student-athlete and their return to athletic and academic activities. The Clemson University Sports Medicine Staff will use the Concussion Assessment Symptom Scale and a Balance Error Scoring System (BESS) daily, along with other examinations deemed necessary during the evaluation of the concussed student-athlete, to determine how quickly the Return-to-Play and progression is performed. The following stages are to be followed